Onkoderma-Clinic for Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria.
Department of Pathology, University of Virginia Health System, Charlottesville, Virginia.
Dermatol Ther. 2020 Jan;33(1):e13200. doi: 10.1111/dth.13200. Epub 2020 Jan 6.
We present a 32-year-old man with successful treatment and remission of mycosis fungoides of both axillae in 2016 after PUVA therapy and systemic and local administration of corticosteroids. Subsequently, in 2017, the patient also achieved remission of a T-cell CD 30 positive, ALK-1 negative large-cell lymphoma of a retroperitoneal and inguinal lymph node after chemotherapy and radiotherapy. One year later, in 2018, the patient presented to our clinic with progression of skin lesions in both axillary areas and the appearance of а tumor in the right gluteal region.Dermatological examination showed livid-to-erythematous, partly sclerotic plaques in the right inguinal area, cutis laxa-like plaque formations in the right axillary region with similar but less-developed changes in the left axillary fold, a solitary subcutaneous tumor formation affecting the entire right gluteal region, and enlarged, palpable lymph nodes in the right para-axillary area. Biopsies were obtained from an axillary lesion and the surgically removed axillary lymph nodes, and histological examination revealed changes of granulomatous slack skin in the axilla and reactive inflammatory changes in the lymph nodes. Histology of gluteal tissue showed a "foreign body" type of reaction with sarcoid-like features, where the patient in the past have been injected with anabolic and steroidal drugs. Herein we describe a patient with simultaneous occurrence of granulomatous slack skin type mycosis fungoides and a sarcoid-like reaction. The question remains open whether this represents the so-called sarcoidosis-lymphoma syndrome or, more likely, granulomatous slack skin MF associated with a sarcoid-like reaction of "foreign body" type. The possibility that disturbance of tissue homeostasis by incorporation of certain adjuvants within injections (for example) in the past might have been an inducer of cutaneous T cell lymphoma and sarcoidosis/sarcoid like lesions seems reasonable but also speculative.
我们报告 1 例 32 岁男性患者，2016 年曾因蕈样肉芽肿接受 PUVA 治疗和全身及局部皮质类固醇治疗，双侧腋窝病变缓解。随后，2017 年，该患者还因 T 细胞 CD30 阳性、ALK-1 阴性的腹膜后和腹股沟淋巴结大细胞淋巴瘤接受化疗和放疗后缓解。1 年后，2018 年，该患者因双侧腋窝皮损进展和右侧臀部出现肿瘤就诊于我科。皮肤科检查显示右侧腹股沟区呈青紫色至红斑性、部分硬化性斑块，右侧腋窝呈皮肤松弛样斑块形成，左侧腋窝皱褶亦有类似但不那么明显的改变，右臀部有孤立性皮下肿瘤形成，累及整个右臀部，右侧腋窝旁可触及增大的可触及的淋巴结。从腋窝病变和手术切除的腋窝淋巴结获得活检，组织学检查显示腋窝处有肉芽肿性皮肤松弛样改变，淋巴结有反应性炎症改变。臀部组织学显示“异物”型反应，具有类肉瘤样特征，患者过去曾注射过合成代谢和类固醇药物。在此，我们描述了 1 例同时发生肉芽肿性皮肤松弛样蕈样肉芽肿和类肉瘤样反应的患者。目前尚不清楚这是否代表所谓的肉瘤病-淋巴瘤综合征，还是更可能是与“异物”型类肉瘤样反应相关的肉芽肿性皮肤松弛样 MF。过去注射某些佐剂（例如）引起组织内稳态紊乱，可能是皮肤 T 细胞淋巴瘤和肉瘤病/类肉瘤样病变的诱导因素，这种可能性似乎合理，但也只是推测。
